Effect of sevoflurane inhalation for different time on postoperative cognitive function of elderly patients with abdominal surgery
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摘要:目的 探讨七氟烷吸入不同时间对老年腹部手术患者术后认知功能的影响。方法 将80例行腹部手术的老年患者根据手术麻醉方案分为半程组和全程组，每组40例。半程组于麻醉诱导60 min后停用七氟烷，并单一使用丙泊酚维持麻醉；全程组术中全程使用七氟烷维持麻醉。采用蒙特利尔认知评估量表（MoCA）及智力状态检查量表（MMSE）评价2组患者术前及术后48 h的认知功能。比较2组患者人细胞间黏附因子-1（ICAM-1）及神经特异性蛋白（S100-β）水平、术中脑电双频指数值、术后苏醒时间以及拔管时间。结果 术后48 h，半程组MMSE评分及MoCA评分均较术前降低，且低于全程组，差异有统计学意义（P < 0.05）。术后48 h，2组ICAM-1及S100-β水平均较术前升高，且半程组高于全程组，差异均有统计学意义（P < 0.05）。全程组术后苏醒时间短于半程组，差异有统计学意义（P < 0.05）。结论 术中全程给予老年腹部手术患者七氟烷维持麻醉更有利于恢复患者术后认知功能，缩短术后苏醒时间，降低ICAM-1及S100-β水平。Abstract:Objective To explore the effect of sevoflurane inhalation for different time on the postoperative cognitive function of elderly patients with abdominal surgery.Methods Totally 80 elderly patients undergoing abdominal surgery were divided into half-course group and full-course group according to anesthesia schemes, with 40 cases in each group. In the half-course group, sevoflurane was stopped at 60 minutes after anesthesia induction, and propofol was used only to maintain anesthesia, while the full-course group adopted sevoflurane to maintain anesthesia in the whole process. The Montreal Cognitive Assessment Scale (MoCA) and the Mental State Examination Scale (MMSE) were used to evaluate the cognitive functions before and 48 hours after the operation in both groups. Levels of human intercellular cell adhesion molecule-1 (ICAM-1) and neurospecific protein (S100-β), intraoperative value of bispectral index, postoperative recovery time and extubation time were compared between two groups.Results At 48 hours after operation, the scores of MMSE and MoCA in the half-course group were significantly lower than those before operation and in the full-course group (P < 0.05). At 48 hours, the ICAM-1 and S100-β levels after operation in both groups were significantly higher than those before operation, and these indexes in the half-course group were significantly higher than those in the full-course group (P < 0.05). The postoperative recovery time in the full-course group was significantly shorter than that in the half-course group (P < 0.05).Conclusion For elderly patients with abdominal surgery, the full-course application of sevoflurane maintenance anesthesia during operation is more beneficial to the recovery of postoperative cognitive function, which can shorten postoperative recovery time and reduce levels of ICAM-1 and S100-β.
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Keywords:
- sevoflurane /
- inhalation time /
- abdominal surgery /
- cognition function
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表 1 2组患者的一般资料比较(x±s)
组别 n 年龄/岁 性别 体质量指数/(kg/m2) 手术时间/min 疾病类型 男 女 结直肠癌 子宫恶性肿瘤 半程组 40 67.31±4.27 17 23 23.16±1.07 130.05±14.15 30 10 全程组 40 66.25±4.25 18 22 22.79±1.14 127.86±4.05 28 12 
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表 2 2组患者的认知水平比较(x±s)
分 组别 n MMSE评分 MoCA评分 术前 术后48 h 术前 术后48 h 全程组 40 27.18±2.33 27.31±1.51 27.50±1.83 27.52±1.30 半程组 40 27.43±1.80 26.28±1.58*# 27.20±2.11 26.00±1.40*# MMSE: 智力状态检查量表; MoCA: 蒙特利尔认知评估量表。与术前比较, * P < 0.05; 与全程组比较, #P < 0.05。
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表 3 2组患者生化学指标水平比较(x±s)
组别 n ICAM-1/(ng/mL) S100-β/(pg/mL) 术前 术后48 h 术前 术后48 h 全程组 40 271.23±50.45 311.12±57.93* 93.16±21.49 97.76±12.26* 半程组 40 268.41±51.06 340.48±62.81*# 92.76±24.61 104.76±13.84*# ICAM-1: 人细胞间黏附因子-1; S100-β: 神经特异性蛋白。与术前比较, * P < 0.05; 与全程组比较, #P < 0.05。
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表 4 2组患者术中脑电双频指数、术后苏醒时间及拔管时间比较(x±s)
组别 n 术中脑电双频指数 苏醒时间/min 拔管时间/min 20 min 40 min 60 min 80 min 100 min 全程组 40 48.08±2.39 49.65±2.77 50.83±2.59 49.40±2.91 51.58±3.15 13.80±3.11 16.43±3.29 半程组 40 47.60±2.24 49.18±2.48 50.35±2.79 49.80±3.10 50.50±3.04 16.43±3.31* 17.78±3.24 与全程组比较, *P < 0.05。
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